+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Mode of delivery and subsequent fertility

Mode of delivery and subsequent fertility

Human Reproduction 29(11): 2569-2574

When compared with vaginal delivery, is Cesarean delivery associated with reduced childbearing, a prolonged inter-birth interval or infertility? Women whose first delivery was by Cesarean section were not significantly different from those who delivered vaginally with respect to subsequent deliveries, inter-birth interval or infertility after delivery. Some studies have suggested that delivery by Cesarean section reduces subsequent fertility, while others have reported no association. This was a planned secondary analysis of the Mothers' Outcomes After Delivery study, a longitudinal cohort study. This analysis included 956 women with 1835 deliveries, who completed a study questionnaire at 6-11 years (median [interquartile range]: 8.1 [7.1, 9.8]) after their first delivery. Exclusion criteria regarding the first birth were: maternal age <15 or >50 years, delivery at <37 weeks gestation, placenta previa, multiple gestation, known fetal congenital abnormality, stillbirth, prior myomectomy and abruption. Of the 956 women included, the first delivery was by Cesarean section for 534 women and by vaginal birth for 422 women. Infertility was self-reported. To compare maternal characteristics by mode of first delivery, P-values were calculated using Fisher's exact test or Pearson's χ(2) test for categorical variables and a Kruskall-Wallis test for continuous variables. We also considered whether, across all deliveries to date, a prior Cesarean is associated with decreased fertility. In this analysis, self-reported infertility after each delivery (across all participants) was considered as a function of one or more prior Cesarean births, using generalized estimating equations to control for within-woman correlation. No differences were observed between the Cesarean and vaginal groups (for first delivery) with respect to infertility after their most recent delivery (7 versus 6%, P = 0.597), the interval between their first and second births (30.8 versus 30.6 months, P = 0.872), or multiparity (75 versus 76%, P = 0.650). Across all births, a history of Cesarean delivery was not significantly associated with infertility (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.64-1.26). Women who reported infertility prior to their first delivery were significantly more likely to report infertility after each subsequent delivery (OR, 5.16; 95% CI, 3.60-7.39). Due to the use of self-reported infertility, the fertility status of some participants may be misclassified. Also, the small sample size may result in insufficient power to detect small differences between groups. Finally, a relatively high proportion of our participants were over age 35 at the time of first delivery (26%) and highly educated (37% with graduate degrees), which may indicate that our population may not be generalizable. While some prior studies have shown decreased family size among women who deliver by Cesarean, our results suggest that the rate of infertility is not different after Cesarean compared with vaginal birth. Our findings should be reassuring to women who deliver by Cesarean section. This study was funded by the US National Institutes of Health (NIH, R01-HD056275). No competing interests are declared. N/A.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 054410111

Download citation: RISBibTeXText

PMID: 25164023

DOI: 10.1093/humrep/deu197

Related references

Mode of delivery in a subsequent pregnancy following previous instrumental delivery. Journal of Perinatal Medicine 41(3): 283-286, 2013

Mode of delivery and subsequent stress response. Lancet 355(9198): 120, 2000

Primary mode of delivery and subsequent pregnancy. Bjog 112(8): 1061-1065, 2005

Previous cesarean delivery: understanding and satisfaction with mode of delivery in a subsequent pregnancy in patients participating in a formal vaginal birth after cesarean counseling program. American Journal of Perinatology 22(4): 217-221, 2005

Mode of delivery and future fertility. British Journal of Obstetrics & Gynaecology 96(11): 1297-1303, 1989

Indications for first caesarean and delivery mode in subsequent trial of labour. Paediatric and Perinatal Epidemiology 27(1): 72-80, 2013

Mode of first delivery and severe maternal complications in the subsequent pregnancy. Acta Obstetricia et Gynecologica Scandinavica 96(9): 1053-1062, 2017

The significance of the mode of delivery for subsequent development of infantile colic. Ugeskrift for Laeger 150(30): 1847-1849, 1988

Subsequent obstetric performance related to primary mode of delivery. British Journal of Obstetrics & Gynaecology 106(3): 227-232, 1999

The effect of diathermy conization of the cervix on subsequent fertility, pregnancy and delivery. Journal of Obstetrics and Gynaecology of the British Commonwealth 75(3): 355-356, 1968

Faecal incontinence and mode of first and subsequent delivery: a six-year longitudinal study. Bjog 112(8): 1075-1082, 2005

Mode of delivery and subsequent reproductive patterns. A national follow-up study. Acta Obstetricia et Gynecologica Scandinavica 93(10): 1034-1041, 2014

Mode of first delivery and women's intentions for subsequent childbearing: findings from the First Baby Study. Paediatric and Perinatal Epidemiology 27(1): 62-71, 2013

Management of third degree perineal tear and choice of mode of delivery in subsequent pregnancies. Journal of Obstetrics and Gynaecology 24(2): 148-151, 2004

Choice of mode of delivery in a subsequent pregnancy after OASI: a survey among Dutch gynecologists. International Urogynecology Journal 28(10): 1537-1542, 2017